EP2324801A1 - Vorrichtung und Verfahren zur Bestimmung einer Implantationskonfiguration eines Glenoidprothesenteils oder einer Anwendungskonfiguration eines Werkzeugs zur Wiederherstellung der Glenoidoberfläche - Google Patents

Vorrichtung und Verfahren zur Bestimmung einer Implantationskonfiguration eines Glenoidprothesenteils oder einer Anwendungskonfiguration eines Werkzeugs zur Wiederherstellung der Glenoidoberfläche Download PDF

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Publication number
EP2324801A1
EP2324801A1 EP10191949A EP10191949A EP2324801A1 EP 2324801 A1 EP2324801 A1 EP 2324801A1 EP 10191949 A EP10191949 A EP 10191949A EP 10191949 A EP10191949 A EP 10191949A EP 2324801 A1 EP2324801 A1 EP 2324801A1
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EP
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Prior art keywords
scapula
glenoid
patient
determining
shoulder
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Granted
Application number
EP10191949A
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English (en)
French (fr)
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EP2324801B1 (de
Inventor
Yves-Alain Ratron
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Tornier SAS
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Tornier SAS
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Definitions

  • the present invention relates to a device and a method for determining an implantation configuration in a patient of a glenoid component of a shoulder prosthesis. It also relates to a device and a method for determining an application configuration of a glenoid resurfacing tool.
  • US-2009/0226068 proposes to manufacture a "tailor-made" glenoid component whose articular surface is shaped, at the time of its conception, taking into account the wear observed on the prosthesis glenoid of a patient. Such an approach is however expensive since it leads to customize the glenoid component for each patient to be treated. Moreover, US-2009/0226068 plans to implant these glenoid components "custom-made" in the traditional way, so that there is still a risk that the implementation finally achieved is not fully satisfactory, for the reasons explained above.
  • the purpose of the present invention is to optimize either the implantation configuration of a glenoid component or the configuration of a glenoid resurfacing tool, taking greater account of the action, on the shoulder joint prosthesis or resurfacing of a patient, forces of muscular origin related to a regular joint activity of this patient.
  • the subject of the invention is a device for determining a configuration in which either a glenoid component of a shoulder prosthesis is to be implanted on the scapula of a patient, or a glenoid resurfacing tool is to be applied to the scapula of a patient, this device being as defined in claim 1.
  • the invention also relates to a method for determining a configuration in which either a glenoid component of a shoulder prosthesis is to be implanted on the scapula of a patient, or a glenoid resurfacing tool is to be applied to the scapula of a patient, said method being as defined in claim 10.
  • One of the basic ideas of the invention is to seek to position a pre-existing glenoid component not when the shoulder joint of the patient to be operated is considered at rest, but when this joint is considered to be subjected to forces.
  • forces of muscular origin related to a regular activity of this patient, typically an articular activity that this patient repeats several times a day.
  • the invention exploits data relating to the observed wear of the glenoid surface of the patient.
  • an implantation configuration of the glenoid prosthetic component can be determined by considering the positional influence of this resultant of forces on joint cooperation between the scapula and the patient's humerus.
  • the efforts related to the regular activity of the patient will be applied in a balanced manner. on the articulation between the prosthetic shoulder blade and the humerus, so that the patient can resume this regular activity by limiting the risk that the latter quickly lead to instability of the implanted prosthesis.
  • the invention can be applied to a glenoid component of a total shoulder prosthesis, the head of the patient's humerus then being prosthesis by a humeral component of the shoulder prosthesis.
  • the invention can also be applied to a glenoid prosthetic component intended to articulate directly on the natural articular head of the patient's humerus.
  • the invention applies equally well to glenoid components whose concave articular surface, as to components with convex articular faces.
  • the latter can be implemented in the context of glenoid resurfacing of the scapula of a patient, typically by milling.
  • the invention then applies to the positioning of the milling tool on the scapula.
  • the determination method according to the invention advantageously has additional aspects which respectively correspond to the implementation of the advantageous additional characteristics listed above for the determination device.
  • mapping data is acquired by palpation of the patient's scapula.
  • mapping data is acquired by palpation of the patient's scapula.
  • a shoulder of a patient including a scapula S and a humerus H.
  • the scapula S delimits, on its lateral side facing the humerus H, a glenoid surface G.
  • the head T of the humerus H is articulated against the surface
  • the articular cooperation between the scapula S and the humerus H is controlled by muscles extending between the scapula and the humerus, in particular the deltoid muscle and the muscles of the uterus. the rotator cuff.
  • the term "muscular environment" is used to designate the aforementioned muscles.
  • a shoulder prosthesis known per se, comprising a glenoid component 1 and a humeral component 2.
  • these glenoid 1 and humeral 2 components have respective global forms of cup portion, delimiting respective articulating faces 1A and 2A geometrically complementary to each other so that these components are articulated one on the other.
  • mapping data relating to the natural geometry of the glenoid surface G are advantageously extracted from pre-operative images of the scapula S, in particular scanner images.
  • the figure 2 corresponds, in a way, to such a pre-operative image.
  • the wear of the glenoid surface G is characterized.
  • the glenoid surface G has, in its lower part and along its entire antero-posterior dimension, a worn zone G 1 , seen in section on the figure 2 , being noticed that the gléno ⁇ d wear is rather noted most often in the upper part of the gléno ⁇ d surface.
  • the worn zone G 1 is characterized by its geometric characteristics, which are appreciated relative to the rest of the glenoid surface G.
  • the worn area G 1 is characterized by the dimensions of its peripheral contour in the three directions of the registration system 10, its depth gradients in the registration system 10, and so on.
  • these geometric wear characteristics are chosen to allow, as explained in detail below, to "go back" to the mechanical causes causing the wear of the glenoid surface G.
  • glenoid surface mapping data G obtained previously, with data relating to the anatomy of a reference glenoid surface, such comparison data being provided by a base of pre-existing data.
  • mapping data relating to only a part of the glenoid surface G considered as unused, to model a theoretical glenoid surface, by means of algorithms for the recognition of forms and genetic data and pre-established morphometric data, and then compare the remaining mapping data, in particular those relating to the used area G 1 , to this theoretical glenoid surface.
  • the advantage of having the geometrical wear characteristics of the glenoid surface G is, in a subsequent step, to use these characteristics to estimate the forces responsible for the formation of the worn area G 1 .
  • the appearance and evolution of the worn out area G 1 within the glenoid surface G are the consequence of the regular and repetitive action of a certain configuration of the muscular environment of the patient's shoulder: because of a regular joint activity of the patient, that is to say gestures that he frequently repeats as part of his daily life, the muscular environment of the shoulder applies to the scapula S and to the humerus H repeated stresses which, in the long run, lead to the appearance and development of the wear of the glenoid surface G at the zone G 1 .
  • This action of the muscular environment can be represented by a resultant of forces, noted F on the figure 2 , whose vector characteristics are determined from the geometrical wear characteristics of the glenoid surface G.
  • a pre-existing musculoskeletal shoulder model is advantageously used.
  • Such a bio-mechanical model can simulate joint movements of the shoulder, quantifying the forces in the joint between the scapula and the humerus of the shoulder, as well as in the muscular environment of the shoulder.
  • a model musculoskeletal shoulder can be used to build a database of wear: to do this, we simulate several glenoid wear in this model, respectively under the action of different predetermined forces corresponding.
  • an optimal implantation position of the glenoid component 1 on the scapula S is determined so that, in subsequent service, the glenoid component opposes the resultant of F.
  • the musculoskeletal shoulder model mentioned above is again used to simulate the articulation between the scapula S and the humerus H, subjected to muscular efforts corresponding to the resultant F and then calculate, in the registration system 10, the geometric characteristics of an implantation position of the glenoid component 1 so that the relative mobility between the latter and the humeral component 2 is balanced under the effect of the In practice, this balancing is advantageously determined so that, during the movements of the prosthetic shoulder producing efforts of resultant F, the area of articular contact between the scapula S and the humerus H is substantially centered relative to the peripheral contour of the glenoid component, and not shifted to a peripheral portion of the latter.
  • the aforementioned geometric characteristics relating to the implantation position of the glenoid component. 1 quantify all the positioning parameters vis-à-vis the scapula S in the registration system 10, namely its height in the three directions of the registration system, and its inclination in these three directions.
  • the implantation position of the glenoid component 1 thus determined is shown on the figure 3 which illustrates the balancing between glenoid component 1 and the humeral component 2 while the scapula S and the humerus H of the shoulder of the patient to be operated undergo the effect of the resultant of forces F.
  • the figure 4 illustrates another implantation configuration according to which the glenoid component 1 is placed without taking into account the resultant of forces F: in this case, unlike the figure 3 it is found that the position of the component 1 does not satisfactorily balance the action of the resultant F on the mobility of the prosthetic shoulder, so that as soon as the patient returns to his daily activities and at each once it repeats the gestures that led to the appearance of the worn area G 1 of its glenoid surface G, the shoulder prosthesis will be solicited according to an unbalanced configuration between its components 1 and 2, from where, at the long, a significant risk of instability of the prosthesis.
  • a preferential position of implantation of the glenoid component 1 on the scapula S has been determined, which preferential position takes into account the action of the resultant of forces F on the prosthesis joint between the shoulder blade and the humerus H of the patient.
  • the different steps of this method can be implemented outside a surgical procedure, properly speaking, aimed at implanting the glenoid component 1, in the sense that these steps are implemented without having to actually access the the scapula S and the humerus H of the patient, in particular via incisions of the soft parts surrounding these bones.
  • this set 12 comprises a computer 14 associated with a unit for transmitting and receiving infrared radiation, this unit comprising a sensor 16 connected to the computer and an infrared power source 18 covering the operating field in which is represented the scapula S of the patient.
  • the assembly 12 comprises a group of markers 20 which passively return the infrared radiation towards the sensor 16.
  • This group of markers 20 forms a three-dimensional marking system allowing the sensors 16 to follow in space the position of the scapula.
  • the use of such markers is well known in the field of computer-assisted orthopedics, for example in the document EP-A-1,249,213 , so these markers will not be described here further.
  • the computer 14 is also associated with a video screen 22 able to display information useful to the surgeon, in particular the information relating to the location of the scapula S and other data described below, preferably in the form of graphic representations.
  • the assembly 12 also comprises control means 24, for example in the form of a pedal actuable by the foot of the surgeon.
  • the computer 14 establishes an unequivocal link between the spatial registration using the marker group 20 and the registration system 10. used for the implementation of the method for determining this preferred implantation position.
  • the surgeon uses, for example, a probe 26 which is identified by the sensor 16, with a prior calibration: after incision of the soft parts of the patient's shoulder, the surgeon brings this probe 26 at least in the remarkable places of the scapula S used to define the tracking system 10 and, by actuation of the control pedal 24, the surgeon has the computer 14 record the position of the probe 26. Then, from these data, the computer 14 is able to calculate the mathematical link between the registration system 10 and the spatial registration of the sensors 16.
  • the surgeon then sets up the glenoid component 1 on the scapula S according to the preferred implantation position.
  • the corresponding gestures of the surgeon are advantageously guided by navigation means controlled by the computer 14. This aspect of surgical guidance is well known in the orthopedic field and will therefore not be described here further.
  • mapping data may thus complete or even constitute in full the mapping data used for the implementation of the method for determining the preferred implantation position of the glenoid component 1: in other words in this case, the implementation of this determination method is performed peroperatively, unlike the case mentioned above where the implementation of this method has been described as being pre-operation.
  • mapping data relating to the scapula S are thus obtained intraoperatively by means of the probe 26 brought to the glenoid surface G.

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EP10191949.6A 2009-11-24 2010-11-19 Vorrichtung und Verfahren zur Bestimmung einer Implantationskonfiguration eines Glenoidprothesenteils oder einer Anwendungskonfiguration eines Werkzeugs zur Wiederherstellung der Glenoidoberfläche Active EP2324801B1 (de)

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US11278299B2 (en) 2017-07-11 2022-03-22 Howmedica Osteonics Corp Guides and instruments for improving accuracy of glenoid implant placement
US12178455B2 (en) 2017-07-11 2024-12-31 Howmedica Osteonics Corp. Guides and instruments for improving accuracy of glenoid implant placement
US11166733B2 (en) 2017-07-11 2021-11-09 Howmedica Osteonics Corp. Guides and instruments for improving accuracy of glenoid implant placement
US12324598B2 (en) 2017-07-11 2025-06-10 Howmedica Osteonics Corp. Guides and instruments for improving accuracy of glenoid implant placement
US11076873B2 (en) 2017-07-11 2021-08-03 Howmedica Osteonics Corp. Patient specific humeral cutting guides
US10959742B2 (en) 2017-07-11 2021-03-30 Tornier, Inc. Patient specific humeral cutting guides
US12193939B2 (en) 2017-12-29 2025-01-14 Howmedica Osteonics Corp. Patient specific humeral implant components
US12616488B2 (en) 2024-04-11 2026-05-05 Howmedica Osteonics Corp. Patient specific instruments and methods for joint prosthesis

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US11911277B2 (en) 2024-02-27
US20160038250A1 (en) 2016-02-11
EP2324801B1 (de) 2021-05-12
FR2955481B1 (fr) 2013-06-14
US20200390556A1 (en) 2020-12-17
US20240156606A1 (en) 2024-05-16
US10195036B2 (en) 2019-02-05
US20170112627A1 (en) 2017-04-27
US10695185B2 (en) 2020-06-30
US9211199B2 (en) 2015-12-15
US9575931B2 (en) 2017-02-21
US20190117404A1 (en) 2019-04-25
FR2955481A1 (fr) 2011-07-29
US20110119884A1 (en) 2011-05-26

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